Determination of risk factors for pacemaker requirement following rapid-deployment aortic valve replacement†

Rahmanian, Parwis B.; Eghbalzadeh, Kaveh; Kaya, S.; Menghesha, Hruy; Gerfer, Stephen; Liakopoulos, Oliver J.; Choi, Y.-H.; Wahlers, Thorsten

doi:10.1093/icvts/ivy056

Cited by 9 publications

(10 citation statements)

References 25 publications

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“…Besides, several studies discuss a preexisting right bundle branch block (RBBB) to be independently predictive for PPM after RDAVR, whereas 5% of our PSM PER collective showed a preoperative RBBB. 31,32 In line with this, RBBB as a preexisting conduction disturbance is a significant predictor of PPM after TAVI, with 3.4% in our discussed NEO TAVI collective. 33 New-onset conduction disturbances leading to higher degree AV block after TAVI, and RDAVR, might be the result of radial force from the prostheses stent frame on the AV conduction system.…”

Section: Valve-related Outcomessupporting

confidence: 76%

Comparison of Self-Expanding RDV Perceval S versus TAVI ACURATE neo/TF

Gerfer

Mauri

Kuhn

et al. 2021

Thorac Cardiovasc Surg

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Background Rapid deployment aortic valve replacement (RDAVR) and transcatheter aortic valve implantation (TAVI) have emerged as increasingly used alternatives to conventional aortic valve replacement to treat patients at higher surgical risk. Therefore, in this single-center study, we retrospectively compared clinical outcomes and hemodynamic performance of two self-expanding biological prostheses, the sutureless and rapid deployment valve (RDV) Perceval-S (PER) and the transcatheter heart valve (THV) ACURATE neo/TF (NEO) in a 1:1 propensity-score-matching (PSM) patient cohort. Methods A total of 332 consecutive patients with symptomatic aortic valve stenosis underwent either singular RDAVR with PER (119) or TAVI with NEO (213) at our institutions between 2012 and 2017. To compare the unequal patient groups, a 1:1 PSM for preoperative data and comorbidities was conducted. Afterward, 59 patient pairs were compared with regard to relevant hemodynamic parameter, relevant paravalvular leak (PVL), permanent postoperative pacemaker (PPM) implantation rate, and clinical postoperative outcomes. Results Postoperative clinical short-term outcomes presented with slightly higher rates for 30-day all-cause mortality (PER = 5.1% vs. NEO = 1.7%, p = 0.619) and major adverse cardiocerebral event in PER due to cerebrovascular events (transient ischemic attack [TIA]-PER = 3.4% vs. TIA-NEO = 1.7%, p = 0.496 and Stroke-PER = 1.7% vs. Stroke-NEO = 0.0%, p = 1). Moreover, we show comparable PPM rates (PER = 10.2% vs. NEO = 8.5%, p = 0.752). However, higher numbers of PVL (mild—PER = 0.0% vs. NEO = 55.9%, p = 0.001; moderate or higher—PER = 0.0% vs. NEO = 6.8%, p = 0.119) after TAVI with NEO were observed. Conclusion Both self-expanding bioprostheses, the RDV-PER and THV-NEO provide a feasible option in elderly and patients with elevated perioperative risk. However, the discussed PER collective showed more postoperative short-term complications with regard to 30-day all-cause mortality and cerebrovascular events, whereas the NEO showed higher rates of PVL.

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Section: Valve-related Outcomessupporting

confidence: 76%

Comparison of Self-Expanding RDV Perceval S versus TAVI ACURATE neo/TF

Gerfer

Mauri

Kuhn

et al. 2021

Thorac Cardiovasc Surg

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“…A routine transthoracic echocardiography (TTE) was performed in all patients before hospital discharge (Philips GmbH, Hamburg, Germany) to assess RDV function. The following routine parameters were recorded as previously defined in detail 16 : MPG and peak pressure gradients (PPGs), PVL grade (1 ¼ mild; 2 ¼ moderate; 3 ¼ severe), indexed effective orifice area (iEOA; ratio EOA/patient body surface area [BSA]). Severe patient-prosthesis mismatch (PPM) was defined as iEOA less than 0.65 cm 2 /m 2 .…”

Section: Surgical Technique and Study End Pointsmentioning

confidence: 99%

Rapid Deployment Aortic Valve Replacement with the Perceval S and Intuity Elite

Liakopoulos

Gerfer

Rahmanian

et al. 2020

Thorac Cardiovasc Surg

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Background Rapid deployment aortic valve replacement (RDAVR) has emerged as an alternative to conventional aortic valve replacement. This single-center study retrospectively analyzed clinical outcomes and hemodynamic performance of the Perceval S (LivaNova) and Intuity Elite (Edwards LifeSciences) rapid deployment valves (RDVs) in a propensity score matched patient cohort. Methods A total of 372 consecutive patients with symptomatic aortic valve stenosis underwent RDAVR between 2012 and 2018 at our institution. The Intuity Elite (INT group) and Perceval S (PER group) were implanted in 251 and 121 patients, respectively. After 1:1 propensity score matching for relevant preoperative comorbidities, 107 patient pairs were compared with respect to relevant perioperative data including hemodynamic parameter, postoperative pacemaker implantation, and 30-day all-cause mortality. Results Propensity score matching resulted in balanced characteristics between groups. Cardiopulmonary bypass and aortic cross-clamp time did not differ between groups, but more patients in the INT group received coronary artery bypass grafting compared with the PER group (56 vs. 42%; p = 0.055). Thirty-day mortality (4.7 vs. 2.2%) and need for permanent pacemaker implantation (7 versus 4.4%) were comparable between the INT and PER groups for isolated AVR and also for combined procedures, respectively. Cerebrovascular events showed comparable low rates for both RDVs (INT group [1.9%] vs. PER group [2.8%]). Indexed effective orifice area was higher in the INT group (0.90 vs. 0.82 cm2/m2) and coupled to a lower peak (17 ± 7 vs. 22 ± 8) and mean (10 ± 5 vs. 12 ± 4) pressure gradients compared with the PER group. Conclusions Our propensity score analysis in AVR patients showed good hemodynamic characteristics with comparable 30-day mortality rate and complications rates for both investigated RDVs.

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“…Furthermore, the development of a postoperative LBBB in patients with preoperative RBBB may lead to a complete AV block. Nevertheless, the presence of a preoperative right-sided CD appeared as one of the most powerful predictors of PPI in our analysis, as in previous studies on transcatheter, sutureless, and standard surgical prostheses (4,(13)(14)(15)(16)(17). For this reason we don't recommend implantation of a RDB in patients with preoperative RBBB.…”

Section: Discussionmentioning

confidence: 56%

Conduction disorders after aortic valve replacement with rapid-deployment bioprostheses: early occurrence and one-year evolution

D’Onofrio

Tessari

Bagozzi

et al. 2020

Ann Cardiothorac Surg

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Background: Rapid-deployment bioprostheses represent one of the newest aortic valve substitutes introduced into clinical practice. The aim of this retrospective single-center study was to evaluate the occurrence of conduction disorders (CDs) after rapid-deployment aortic valve implantation at discharge and at 1-year follow-up, and to identify risk factors for CDs and permanent pacemaker implantation (PPI). Methods: All patients who reached 1-year follow-up after isolated or combined aortic valve replacement (AVR) with rapid-deployment bioprostheses (Intuity Elite, Edwards Lifesciences, Irvine, CA) at our institution were included in this study. Standard 12-lead electrocardiograms (ECGs) were recorded before the procedure (within 24 hours), after the procedure as soon as the patient was moved to the intensive care unit (ICU), every day during in-hospital stay and at 1-year follow-up. The primary endpoint was the incidence of postoperative CDs at discharge and at 1-year follow up. Patients were divided in two groups: those who developed the primary endpoint (Group CD) and those who didn't (Group Non-CD). Results: A total of 98 consecutive patients were included in the study. At discharge, the primary endpoint occurred in 40 patients (40.8%). In particular, new CDs and PPI occurred in 33 (33.7%) and in 7 (7.1%) patients, respectively. Valve size was the only independent predictor of primary endpoint at discharge. At 1-year, 30 patients (31.3%) presented with CDs or pacemaker-induced rhythm. In particular, in 25 patients of Group CD (64.1%), 1-year follow-up ECG revealed the persistence of the same CD as at discharge or pacemaker-induced rhythm, while 14 patients (35.9%) showed recovery of their CD. Age and prosthesis size were identified as independent predictors of CDs/pacemaker-induced rhythm at 1-year follow-up. Conclusions: According to our data, nearly 40% of patients develop a new CD after rapid-deployment aortic valve implantation. Of these, one third recover after one year. Bioprosthesis size and age were identified as independent risk factors for occurrence of CD after surgery.

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Determination of risk factors for pacemaker requirement following rapid-deployment aortic valve replacement†

Cited by 9 publications

References 25 publications

Comparison of Self-Expanding RDV Perceval S versus TAVI ACURATE neo/TF

Comparison of Self-Expanding RDV Perceval S versus TAVI ACURATE neo/TF

Rapid Deployment Aortic Valve Replacement with the Perceval S and Intuity Elite

Conduction disorders after aortic valve replacement with rapid-deployment bioprostheses: early occurrence and one-year evolution

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